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States Welcome Flu Plan but Say They Need Federal Money

WASHINGTON, May 3 — State and local health officials said they welcomed the federal government's latest plan for dealing with a pandemicflu outbreak, but some complained that the Bush administration had failed to provide the money needed to pay for the plan's long list of recommendations.

The plan, presented Wednesday, is the latest effort by the administration to detail how federal, state and local agencies would react if a virulent flu strain threatened the United States. Closing the nation's borders is not among its recommendations.

"We don't expect that a tight shutdown of the borders would actually stop it from arriving here," the president's homeland security adviser, Fran Townsend, said at a news conference.

The plan also says such a shutdown would be costly.

The government would, however, probably limit the number of airports that accept international flights and would closely screen travelers.

Domestic travel could also be restricted, and officials would probably advise the cancellation of vacations, would advise people to keep a distance of three feet from others and, perhaps, keep children home from school.

The plan comes amid international worries about a particularly virulent strain of bird flu that has killed many flocks of wild and domesticated birds. The virus has sickened 205 people and killed 113, but has not transmitted easily among humans.

If it did become easily transmissible, some experts say it could kill tens of millions of people. Other experts say that such a transformation is highly unlikely.

"I should make it clear from the outset that we do not know whether the bird virus that we are seeing overseas will ever become a human virus," Ms. Townsend said. "Moreover, there is no way to predict how severe a pandemic would be."

The 227-page plan estimates that a third of the population could become infected, two million people could die, 40 percent of employees might be absent from work during the height of the outbreak, and $600 billion in income could be lost nationwide.

If rioting broke out and overwhelmed the National Guard, the plan says, the president could call out the Army to establish order.

Dr. Josh Sharfstein, commissioner of the Baltimore Health Department, said the plan was welcome but offered "new expectations without new resources."

The plan asks local governments to deal with a flood of hospital patients, care for more patients at home and spend millions of dollars on antiviral drugs, Dr. Sharfstein said.

Congress has appropriated $3.8 billion to pay for preparations like drug and vaccine purchases. The Bush administration has spent $1.8 billion of that appropriation, although Ms. Townsend said that all the money would be spent by October.

Senator Tom Harkin, Democrat of Iowa, who advocated preparations for a pandemic, said the administration had been slow in implementing plans and spending money already appropriated.

A bill to provide another $2.3 billion for flu preparations is moving through Congress, and Ms. Townsend said the administration expected to ask for an additional $1 billion in 2008.

In November, President Bush released a different flu plan that mostly described how public health officials would react to an outbreak.

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The plan was criticized as lacking details needed to avoid the kind of confusion that bedeviled the government's response to Hurricane Katrina. The administration promised to provide those details and delivered many of them on Wednesday.

Divided into nine chapters, the plan provides a list of actions federal departments must complete as a pandemic spread.

A major point of contention in the past year has been about who should be in charge of the government's response.

The plan says that the secretary for health and human services would lead the federal health and medical response but that the secretary for homeland security "is responsible for coordination of federal operations and resources."

Senator Hillary Rodham Clinton, Democrat of New York, said that failed to resolve the issue of leadership. "Under the president's plan," Mrs. Clinton said, "we still don't know who is accountable within our federal government."

Experts have also debated who should be vaccinated first — police officers or doctors, undertakers or food deliverymen, military personnel or the border patrol? The question still has not been resolved.

"We are actively discussing those issues across the government," Ms. Townsend said.

The issue is important because a vaccine is likely to take at least five months to manufacture from the time an outbreak appears.

Mary Selecky, secretary of health for Washington, said the administration plan would help her state align its efforts with those of the federal government. She said she was pleased that the administration promised a plan to deal with international travelers.

"In the Northwest, we have 42,000 travelers going and coming from Asia every week," Ms. Selecky said. "We don't want to have to deal in an isolated way with a plane carrying potentially infected people."

Like her counterparts in other states, she complained that the administration was not helping states to finance flu preparations.

"They gave us a list of work that they expect us to do," Ms. Selecky said, "but they've only given us a little bit of one-time money. We need a sustained effort."

Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, echoed the state officials' complaints, saying: "There's a disconnect between the rhetoric about what's needed and the resources on the table. This is the mother of all unfunded mandates."

Dr. William Schaffner, chairman of the preventive medicine department at Vanderbilt University, called the plan "realistic" in advising against shutting the borders and said that cities and states need to prepare.

"Localities cannot rely on the feds to be the cavalry that rides over the hill to rescue every U.S. town and city from pandemic influenza," Dr. Schaffner said.

Lawrence K. Altman and Donald McNeil contributed reporting from New York for this article.

A version of this article appears in print on , on Page A20 of the New York edition with the headline: States Welcome Flu Plan but Say They Need Federal Money. Order Reprints|Today's Paper|Subscribe